Bull. tnd. Inst. Hist. Moo. Vol. XXV 38 to 45

FILARIASIS (SHLIPADA)

P.K. WARRIER*

ABSTRACT

Filariasis is known to medical science over many centuries. It

is a disease of tropical countries due to the presence of micro-

filaria. The effected areas are large and elephantoid in appearance,

so it is called' Elephantiasis '. A non- parasitic form of Elephantiasis

occurs when the lymphatics are blocked. In Ayurveda this disease

is termed as Shlipada.

Filariasis, a disease known tothe medical science over many cen-

turies, still defies a cure and henceit calls for extensive discussions. Itis the disease due to the presence offilaria in blood and lymphatic sys-

tem. Filaria is a parascitic threadlike organism. Filarial elephantiasis

is described as a disease of tropicalcountries due to the presence of

micro - filaria - as the worm is calledbecause of its microscopic size. It

is introduced by the Culex mosquito.

Three months after the infection of

filaria the changes which occur inthe tissues give rise to blockage of

the lymphatics. Because of that the

lymph nodes enlarge particularly ofthe legs and the external genitalia.

The affected areas are large andelephantoid in appearance. So it is

called elephantiasis. The skin turns

thick and covered with scabs. The

condition is not painful, but it isextremely disfiguring and it limits

movement and the ability to work

which causes frustation and un-

happiness. A non-parasitic form of

elephantiasis occurs when the lym-

phatics are blocked, in intractablecases of varicose veins and certain

types of carcinoma and as a sequel

* Managing Trustee & Chief Physician, Arya Vaidyashala, Kottakkal - 676 503, Kerala.

Filariasis (Shlipada) - Warrier

to any chronic septic local condi-tions.

In filariasis, according to the

modern medicine, the only effectivedrug is diethyl carbamazine cit-rate.

Tight bandaging of the legs may behelpful. Surgical treatment does not

ensure cure. In Ayurvedic literatureit is termed as Shlipada. In the

thirtieth chapter in the UUarasthanaof Ashtangahridaya of Vagbhata, itis presented along with the descrip-tion and treatments of other dis-

eases as Granthi, Arbuda, Apachiand Nadivrana clubbed together, as

all of these are related to Sopha(inflammation) and being cornptlcateo,treatment also is very difficult.

Regarding the aetiology of Shli-

pada Vagbhata says, The bodily humors(doshas) all together with the pre-dominance of Kapha through fleshand blood move to the lower part of

the body as the inguinal region and

thigh in course of time having made

the feet as the base create thickswelling (Sopham) which is termed

as Shlipada.' Shlipada whenoccurs by Vatadosa, it is with small

eruptions, dark in colour, paining

without cause, rough and dry in

39

appearance". By Pittadosa it iscoloured yellow with burning sensa-tion and tever>. By Kaphadosa the

shlipada is heavy, big, unctuous andwithout pain and surrounded by nodesof flesh", Shlipada with a durationof more than a year and of very bigsize', and with excessive discharges

are to be abandoned i.e. "not de-

penda ble for successfu I treatrnent'".

Some say that shlipada appears

on palm, nose, lips and ears as onthe legs. Because of the nature of

the disease its incidence is more in'Anupa' places. (Anupa is one vari-ety of localities described in Ayur-veda which are classified according

to the nature of places)". Treatmentof Shlipada is described in the ~Oth

chapter as follows:

In all Shlipedas, venesection isprescribed. In Vatika type vein twofinger-girth above the ankle is to be

cut. But before doing Siravedha

(venesection) one must be subje-

cted to proper lubrication, sudationand the part is also treated with

Upanaha as purvakarma (prepara-

tory steps). Then the patient is to

take castor oil with cow's urine. Whenthe medicine is properly digested,

1 to 6 to be reffered at page no. 44

40

the patient is to be fed with the

cooked rice of one year old grainwith milk boiled with dry ginger or

turpith. Even then if it is not in

control, cauterisation is suggested.In the case of a.Paittika Shlipada thevein under the ankle is to be cut and

then medicines and food, good for

curing Pitta in general, are to be

followed. In a Kapha predominatingShlipada, the vein on the big toe is

to be cut. The patient is to take foodwith Indian barley as main. Decoc-

tions with honey, Haritaki (Chebulicmyrobalan) in Increasing doses, are

to be taken in. Mustard, brinjal orcoriander are to be used for apply-ing as Lepas. The above are thegeneral directions to treat Shlipada.

Now coming to practical expe-rience, physicians of Kerala can-not lag behind, since most parts ofKerala are Anupa and filariasis is

endemic in these places. Areas likeCherthala, Cochin, Ponnani and other

coastal regions with backwaterhinter-lands, are the localities where

filariasis had been endemic in all itsforms. So physicians of Kerala

were forced to cope up with curingthe troubles and some techniques

Bu//. Ind. Ins!. His!. Med. Va/.XXV

have shown good results even in oldcases, although filariasis is consid-

ered beyond our control even after

one year. Below, we indicate one

such technique practised by an oldphysician and which in our own ex-perience also has proved its claim.

In the treatment of filariasis, thefirst and most important step is cau-

tion to prevent the attack. In this,protection from mosquitos, removal

of stagnant water pools and restraintfrom using impure water are impor-

tant. People who live in these placesor others who are forced to live there

because of occupational exigencieshave to be very careful in taking

food articles by using protective safe-

guards. Fever and chill are the

preliminary symptoms of most at-tacks and so dietetic articles anddecoctions ac-ting against suchconditions are always advisable. Black

pepper is a very good dietitic ar-ticle, to be used by the inhabitants of

such areas. It is said that theparticular medicine for an endemic

disease also will be available asnatural supply at the same locality.

Black pepper is an example here.

Kerala is the land of heavy rain due

Filariasis (Shlipada) - Warrier

to monsoons and it is also the home-land of black pepper.

Daily use of black pepper in our

food or drinks helps in prevention offilariasis. With the appearance ofthe symptoms one must be careful to

control and cure them as early as

possible. Kerala physicians havemany simple remedies at this stage.

We have experience of a cure insuch an aggravated case by the useofThumba (Leucasaspera) and peppertaken together. It is a very drying

medicine and so the patient adviseto take milk irnrnedtatety and copi-

ously. Our physicians prescribeinternal medicine and external Lepas

on the affected parts.

In Keralite practice, we usually

follow the instructions of'Chikitsamanjari', 'Yogamritam' andother keralite works. The medicinessuggested by these texts are usually

available in the market. Of course,

in "the early stages they are fully

reliable. The first instruction is toadminister purgatives repeatedly.

Sesamum oil boiled and preparedwith the mixture of the juices of

'Nonganampullu' (Hedvotis herbacea)

41

and the tender leaves of 'Manhapa-

vitta' ( Morinda pubescens) and

Sakhotaka (Strebulus asper) is to

be applied on the head.

The sesamum oil cooked with thebetel leaves if taken with the well-churned butter milk and cow's urine

and Haritaki (Chebulic mvroba/an)pacifies the Shlipada.

In the juice of Nonganampullusesarnum oil or castor oil is pre-

pared with the root of Parakam(Strebulus asper) being pounded

and mixed. By using this, the shlipadanot later than of eighteen months'

duration is cured.

Oil taken from the juice of

Nonganampullu is good for internal

use.

Forexternal Lepa, well-powdereaNonganampullu and turmeric and a

handful of raw rice cooked in the

water leaving of rice washes with

moderate heat is used to apply theaffected part covered with the leaf of

Clerodendrum viscosum~ It paci-fies the Shlipadas.

Apply the oil prepared with thejuice of the leaves of Strebulus asper

42

and Hedyotis herbacea adding the

pounded paste of the tubers of Yam.

Apply this oil all over the body. Itprevents fever.

720 grams of Haritaki (Chebu/icmyroba/an) is boiled in 18 litres ofcow's urine and reduced to one

sixth and one litre of oil is preparedin it with the juice of the leaves ofSakhotaka and the pounded paste of

. triphala and punarnava. Take this

oil for 21 days. In this way castor oilwith 1/3 ghee can be taken in.

The fore-going matter pointsout the limited possibilities of treat-ing filariasis under present condi-tions and common practice as reali-

sed now. Cases of elephantiasiswhich have transgressed the ac-cepted period of 18 months are takenas incurable. But it is doubtful whetherthe old Keralite physicians had com-pletely agreed with this verdict. Our

drive to find out more effective thera-peutic measures shall be guided bythe observation and findings recordedby our predecessors who engaged

their -minds in pursuit of well-being

of the ailing humanity. We have

evidence from these records to provethat old practitioners often challenged

Bull. /nd./nst. Hist. Med. Va/.XXV

this verdict and took pains to heal

old cases also, provided the patients

willing to undergo the strenuous tre-

atment strictly. Following the reportof an old physician, Vaidyan K.Kesava

Pillai from Aroor, who worked as aself appointed mission treated 104

cases of elephantiasis with a spe-cial technique successfully,wh-ich

was published in 'Dhanwanthary',the Malayalam medical journal in th :year 1909. Going through that ar-ticle we can understand that having

thought the limitations of the thera-peutic abilities of the then existingmedical systems. Vaidyan K-esavaPillai evolved a line of treatment

from his own observation. Inspiredby the information detailed in the

article, we too tried the same regi-men in a few established cases offilariasis. The results are foundencouraging. The regimen that we

tried here is as follows.

A.Administration of purgative

Avipathi Churnam (10-15 grams,according to the requirements) mix-

ed with warm water is given early in

the morning on empty stomach forthese consecutive alternate days.

(That is to say on Sunday - Tuesday

Filariasis (Shlipada) - Werner

& Thursday).

B.Post purgative Drugschedule

On the last day of adrninlstrationof Avipathi Churnam, Marichadi

Kashayam 15 ml. (diluted with 60

rnl. of warm water) is given after

dinner. Additives to be mixed withMari~hadi Kashayam are (1)

Gorochanadi Pill one (Powdered)

(2) Powder of the root bark of

Narumpanal (Uvarianarum) 500 mg.Next day onwards Marichadi Kasha-

yam, Narumpanal root bark powderand Gorochanadi Pill are given inthe above dosage on empty stomachin the morning and after dinner inthe night. Marichadi Kashayam contains

Maricham (black pepper) and Shunthi

(dried Ginger) in 3:1 proportion.

C. Medicines administered ex-ternally

1) Twice in a week application ofKupilwadi thailam on the headand body before bath. (It con-tains Uvaria narum, Yam tuber,

Piper nigrum, Hordeum vulgare,

strebulus asper, Tinospora

cordifolia, Aristolochia indica,

43

Aquilaria aga//ocha, Ec/ipta

prostrate, Gossypium herbaceumand Myristica malabarica.)

2) Bandage with appropriate cottonclothes smeared with the pow-der of black pepper, being mixedwith the juice of Narumpa-nal on

the affected leg/legs daily at night.

(This is to be removed next day

morning).

3) Liberal application of Nonganadithailam on the affected parts be-

fore tying the above bandage.

4) Wearing a chain made of ripe

dry pepper (just like rosary ofbeads) or Wearing suitably made

cloth bag filled with dry pepperpowder.

5) Wearing a belt made of cloth,filled with pepper powder aroundthe waist.

Duration of treatment

Patients are instructed to continue

the medication without break until'satisfactory improvement is obtained.There is no fixed time-frame for

treatment.

44

Results observed

Fairly good response is seen

in the cases treated on the aboveline. Recurrent attacks offever and

lymphadenitis were reduced re-markably and the ulceration of the

affected area was healed. Thick-ness of the subcutaneous tissue was

Jessened. The treatment helped torestore normal appearance of the

Bull. Ind. Inst. Hist. Med. Vol. XXV

affected leg to a certain extent witha fair degree of improvement.

Guide for further study

Shlipada (Filariasis) and itstreatment, written byVaidyan K.KesavanPillai - reproduced in "Aryavaidyan",

a quarterly journal of the Arya VaidyaSala, Kottakkal (Vo1.8 No.2 issue -

Nov./94) (English translation).

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